| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | SELECT HEALTH | $31K | — | $31K | 2.69% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS LLC | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | ALPHA DENTAL OF UTAH, INC. | $3K | — | $3K | 3.00% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS | 15 W. SOUTH TEMPLE SUITE 700 SALT LAKE CITY, UT 841011533 | METROPOLITAN LIFE INSURANCE COMPANY | $5K | $652 | $5K | 16.00% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | EYEMED VISION CARE | $1K | — | $1K | 9.80% |
| CUSTOM INSURANCE SPECIALISTS INC3 Filed as: CUSTOM INSURANCE SPECIALISTS INC. | 886 E 3200 N KAMAS, UT 84036 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $232 | — | $232 | 5.93% |
| NELLYN COX3 | 2539 KENTUCKY AVENUE SALT LAKE CITY, UT 84117 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $191 | — | $191 | 4.88% |
| MERCER HEALTH AND BENEFITS, LLC3 Filed as: MERCER HEALTH & BENEFITS LLC | 4565 PAYSPHERE CIRCLE CHICAGO, IL 60674 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $188 | — | $188 | 4.81% |
| TIM VINCENT INS AGY INC3 Filed as: TIM VINCENT INSURANCE AGENCY INC. | 3489 WEST 10305 SOUTH SOUTH JORDAN, UT 84095 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $74 | — | $74 | 1.89% |
| KRISTEN ELISE RANDALL3 | 9538 WEST SAN JUAN CIRCLE LITTLETON, CO 80128 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $53 | — | $53 | 1.35% |
| MORETON & COMPANY3 Filed as: MORETON INSURANCE OF COLORADO LLC | 4600 SOUTH ULSTER STREET DENVER, CO 80237 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $19 | — | $19 | 0.49% |
| JILL WHITE3 | 6510 TAMARA DRIVE SALT LAKE CITY, UT 84129 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $12 | — | $12 | 0.31% |
| GINA M WESOLEK3 | 114 LAKE WOOD CIRCLE WOODLAND PARK, CO 80863 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $8 | — | $8 | 0.20% |
No Schedule C service providers reported on this filing.
Benefits declared on the Form 5500 main form (✓ = also has a Schedule A insurance contract; otherwise the benefit is funded out of plan assets or via a Schedule C TPA).
The plan reports several different headcounts depending on which form you read. Each one measures a different slice of the population.
| Active participants | 176 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 2 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 178 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | SELECT HEALTH | 440 | $1.2M |
| Dental | ALPHA DENTAL OF UTAH, INC. | 369 | $109K |
| Vision | EYEMED VISION CARE | 279 | $12K |
| Life insurance | METROPOLITAN LIFE INSURANCE COMPANY | 233 | $34K |
| Long-term disability | METROPOLITAN LIFE INSURANCE COMPANY | 233 | $34K |
| Prescription drug | SELECT HEALTH | 440 | $1.2M |
| Other(2 contracts, 2 carriers) | METROPOLITAN LIFE INSURANCE COMPANY | 233 | $38K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 440 | — |
Why the numbers differ. Form 5500 line 6 counts employees + retirees + beneficiaries; no dependents. Schedule A persons-covered counts everyone enrolled, including spouses and children, so it usually exceeds line 6 by 30-60% on a working-age workforce. The medical row is normally the broadest single line because it has the highest take-up; dental/vision/life often dip below it. Stop-loss / reinsurance contracts sometimes report the carrier's full underwriting pool rather than this filer's headcount; the row is shown for transparency but shouldn't be read as "people in this plan."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.